Lp(a) is not Related to Retinopathy in Diabetic Subjects

PURPOSE

To examine the association between Lp(a) concentrations and the severity of retinopathy in 22 younger-onset and 48 older-onset diabetic subjects from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a population-based study of diabetic retinopathy.

METHODS

We used a subset of the WESDR population with standardized protocols and stereoscopic color fundus photography to determine the severity of diabetic retinopathy in relation to Lp(a) concentrations. Lp(a) concentrations were measured by a monoclonal anti-Lp(a) antibody.

RESULTS

Lp(a) levels were not significantly different between younger-onset or older-onset subjects with and without retinopathy.

CONCLUSION

Our results do not support a link between higher levels of Lp(a) and severe retinopathy in either younger-onset or older-onset diabetic subjects but this needs confirmation in larger prospective studies.

A Pilot Study of Glaucoma Visual Field Screening in Diabetes

Because people with diabetes may be at increased risk of glaucoma, we performed a pilot study using automated visual field testing for screening them. One hundred and seventy-six diabetic persons who had participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy were tested with the Armaly-Drance screening pattern on the Humphrey Visual Field Analyzer. Individuals with moderate diabetic retinopathy or worse tended to have lower sensitivity of the central visual field and missed more points than those with no or only mild retinopathy. People with a history of glaucoma had slightly less sensitivity and missed more points than controls. These preliminary findings suggest that although people with diabetes and glaucoma may more frequently have visual field defects than people with diabetes but no glaucoma, a larger study is needed. This pilot study shows that such a study would be feasible and should be designed to indicate the sensitivity, specificity, and cost-benefit ratio of a screening program so as to assess the utility of the screening visual field test for finding glaucoma amongst people with diabetes.

An Anatomic Index for the Severity of Ocular Injuries

Ocular injuries are a frequent cause of monocular blindness and cause disfigurement and discomfort. We developed a measure of severity for eye injuries using a multi-attribute utility (MAU) model. The severity index scoring was applied to eye injuries that presented at hospitals in Wisconsin, U.S.A. The resulting distribution of severities was compatible with that seen by general eye care physicians. A severity scale provides a means of comparing the severity of injuries from a wide variety of traumatic sources (e.g. automobile crashes, combat injuries, occupational accidents, etc.) and is useful in evaluating preventive and public health measurements.

Breast cancer susceptibility loci in association with age at menarche, age at natural menopause and the reproductive lifespan

Purpose: Genome wide association studies have identified common single nucleotide polymorphisms (SNPs) associated with breast cancer risk. Many of these SNPs have an unknown biologic significance. Hormonal risk factors may mediate the relationships between these loci and breast cancer risk. We explored the relation between breast cancer susceptibility loci and menstrual factors using data from two population-based studies. Methods: In the first dataset, composed of 1328 women ages 20–74 years without a breast cancer diagnosis who participated in an established population-based study conducted in three U.S. states, we used linear regression to assess the associations between 13 previously-identified breast cancer loci with age at menarche, age at natural menopause and the reproductive lifespan. The reproductive lifespan is defined as the time between age at menarche and age at natural menopause, excluding time for pregnancy, oral contraceptive use and lactation. A polygenic risk score created as the sum of the number of risk allele copies in the SNPs was also evaluated for an association with menstrual traits. Significant results were then evaluated in the second dataset comprised of 1353 women ages 43–86 years recruited as part of a cohort study based in Beaver Dam, WI. Results: Polygenic score and 13 loci were not associated with either age at menarche or reproductive lifespan. Two SNPs were associated with age at natural menopause; each increase in the number of copies of the minor allele (A) of rs17468277 (CASP8) was associated with a 1.12 year decrease in age at natural menopause (p = 0.02). The minor allele (G) of SNP rs10941679 (5p12) (p = 0.01) was associated with a 1.01 year increase in age at natural menopause, although these results were not replicated in the follow-up study (p = 0.14 and 0.98, respectively). Conclusions: We did not find evidence to support the hypothesis that breast cancer susceptibility loci are related to menstrual factors.

Diabetic retinopathy in the SEARCH for Diabetes in Youth Cohort: a pilot study

AIMS

The aim of this pilot study was to generate an initial estimate of the prevalence and correlates of diabetic retinopathy in a racially and ethnically diverse sample of youth with Type 1 and Type 2 diabetes mellitus.

METHODS

A pilot study was conducted among 222 individuals with Type 1 diabetes (79% non-Hispanic white, 21% other) and 43 with Type 2 diabetes (28% non-Hispanic white, 72% other), all of > 5 years duration (mean duration 6.8 years) who participated in the SEARCH for Diabetes in Youth study. Diabetic retinopathy was assessed using non-mydriatic retinal photography of both eyes.

RESULTS

The prevalence of diabetic retinopathy was 17% for Type 1 diabetes and 42% for Type 2 diabetes (odds ratio 1.50, 95% CI 0.58-3.88; P = 0.40 adjusted for age, duration, gender, race/ethnicity, parental education and HbA(1c). HbA(1c) was significantly higher among those with any diabetic retinopathy (adjusted mean 79 mmol/mol, 9.4%) vs. no diabetic retinopathy (adjusted mean 70 mmol/mol, 8.6%) (P = 0.015). LDL cholesterol was also significantly higher among those with any diabetic retinopathy (adjusted mean 107.2 mg/dl) compared with those without diabetic retinopathy (adjusted mean 97.9 mg/dl) (P = 0.04).

CONCLUSIONS

The prevalence of diabetic retinopathy in contemporary young individuals was substantial, particularly among minority youth and those with Type 2 diabetes. Further long-term study of diabetic retinopathy in youth is needed.

Cognitive function and retinal and ischemic brain changes: the Women's Health Initiative

OBJECTIVE

To examine the association between retinopathy and cognitive decline or brain lesions and volumes in older women.

METHODS

This study included 511 women aged 65 and older who were simultaneously enrolled in the Women's Health Initiative Memory Study and the Sight Examination Study. In this analysis, we examined the link between retinopathy, assessed using fundus photography (2000-2002), cognitive performance over time assessed by the modified Mini-Mental State Examination (3MSE) (1996-2007), and white matter hyperintensities and lacunar infarcts in the basal ganglia.

RESULTS

Presence of retinopathy was associated with poorer 3MSE scores (mean difference = 1.01, SE: 0.43) (p = 0.019) over a 10-year follow-up period and greater ischemic volumes in the total brain (47% larger, p = 0.04) and the parietal lobe (68% larger, p = 0.01) but not with measures of regional brain atrophy.

CONCLUSIONS

The correspondence we found between retinopathy and cognitive impairment, along with larger ischemic lesion volumes, strengthens existing evidence that retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease that may influence cognitive performance and related brain changes. Retinopathy may be useful as a clinical tool if it can be shown to be an early marker related to neurologic outcomes.

Retinopathy in old persons with and without diabetes mellitus: the Age, Gene/Environment Susceptibility--Reykjavik Study (AGES-R)

AIMS/HYPOTHESIS

We aimed to describe the prevalence of retinopathy in an aged cohort of Icelanders with and without diabetes mellitus.

METHODS

The study population consisted of 4,994 persons aged ≥ 67 years, who participated in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-R). Type 2 diabetes mellitus was defined as HbA(1c) ≥ 6.5% (>48 mmol/mol). Retinopathy was assessed by grading fundus photographs using the modified Airlie House adaptation of the Early Treatment Diabetic Retinopathy Study protocol. Associations between retinopathy and risk factors were estimated using odds ratios obtained from multivariate analyses.

RESULTS

The overall prevalence of retinopathy in AGES-R was 12.4%. Diabetes mellitus was present in 516 persons (10.3%), for 512 of whom gradable fundus photos were available, including 138 persons (27.0%, 95% CI 23.2, 31.0) with any retinopathy. Five persons (1.0%, 95% CI 0.3, 2.3) had proliferative retinopathy. Clinically significant macular oedema was present in five persons (1.0%, 95% CI 0.3, 2.3). Independent risk factors for retinopathy in diabetic patients in a multivariate model included HbA(1c), insulin use and use of oral hypoglycaemic agents, the last two being indicators of longer disease duration. In 4478 participants without diabetes mellitus, gradable fundus photos were available for 4,453 participants, with retinopathy present in 476 (10.7%, 95% CI 9.8, 11.6) and clinically significant macular oedema in three persons. Independent risk factors included increasing age and microalbuminuria.

CONCLUSIONS/INTERPRETATION

Over three-quarters (78%) of retinopathy cases were found in persons without diabetes and a strong association between microalbuminuria and non-diabetic retinopathy was found. These results may have implications for patient management of the aged.

Diphtheria and hearing loss

OBJECTIVE

To determine if infectious diseases usually experienced in childhood have an effect on hearing ability later in life.

METHODS

The Epidemiology of Hearing Loss Study (N = 3,753) is a population-based study of age-related hearing loss in adults aged 48 to 92 years in Beaver Dam, Wisconsin. As part of this study, infectious disease history was obtained and hearing was tested using pure-tone audiometry. Hearing loss was defined as a pure-tone average of thresholds at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz greater than 25 decibels hearing level in either ear.

RESULTS

After adjusting for confounders, only a history of diphtheria (n = 37) was associated with hearing loss (odds ratio [OR] 2.79; 95% confidence interval [CI] 1.05, 7.36). There was no relationship between hearing loss and history of chickenpox, measles, mumps, pertussis, polio, rheumatic fever, rubella, or scarlet fever. Only two participants with a history of diphtheria and hearing loss reported having a hearing loss before age 20.

CONCLUSIONS

Diphtheria in childhood may have consequences for hearing that do not become apparent until later in life. A possible biological mechanism for a diphtheria effect on hearing ability exists: The toxin produced by the Corynebacterium diphtheriae bacteria can cause damage to cranial nerves and therefore may affect the auditory neural pathway. These data may have important implications for areas facing a resurgence of diphtheria cases.

Relationship of dietary fat to age-related maculopathy in the Third National Health and Nutrition Examination Survey

OBJECTIVE

To evaluate the associations between dietary fat and age-related maculopathy (ARM) in persons 40 years or older who participated in the Third National Health and Nutrition Examination Survey.

METHODS

We used a single, nonmydriatic, fundus photograph of 1 eye to ascertain ARM status in 7883 of 11 448 survey participants. Intake of fat was estimated from 24-hour recall, and specific sources of dietary fat were estimated from responses to food frequency questionnaires. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) that accounted for complex survey design, nonresponse, and potential risk factors for ARM (age, smoking, race, sex, body mass index, history of cardiovascular disease or hypertension, eye color, and sedentary lifestyle). Persons aged 40 to 79 years (n = 7405) were included in analyses for early ARM (n = 644); those 60 years or older (n = 4294) were included in analyses for late ARM (n = 53).

RESULTS

After adjustment for age, race, eye color, and sedentary lifestyle, OR for early ARM was 1.4 (95% CI, 0.9-2.2; P for trend,.10) among persons in high vs low quintiles of total fat intake (percentage of total energy). Associations for specific types of fatty acids (as percentages of caloric intake) were in the same direction and unrelated to ARM. The OR for late ARM was 0.7 (95% CI, 0.2-2.6; P for trend,.60) in persons 60 years or older. Further adjustments for other potential confounders did not significantly affect the ORs.

CONCLUSION

Age-related maculopathy was not significantly associated with dietary fat in this large cross-sectional survey.

Aggregation of refractive error and 5-year changes in refractive error among families in the Beaver Dam Eye Study

OBJECTIVE

To examine aggregation of refraction, myopia, hyperopia, and astigmatism, as well as the 5-year change in each of these measures, among adult family members.

DESIGN

Geographically defined, population-based cohort study in Beaver Dam, Wis. Participants were all 43 to 84 years of age in 1988. Family relationships among participants of the study were identified through interviews. The main outcome measures were noncycloplegic refractions. Aggregation was assessed by Pearson correlations and odds ratios (ORs) that both members of a pair were affected.

RESULTS

Age-adjusted sibling correlation of refraction was 0.37 and the OR for a sibling to be myopic was 4.18, whereas the OR for being hyperopic was 2.87 (all statistically significant, P<.05). Correlations and ORs for parent-child and cousin relationships were smaller, and those for spousal relationships were not significant. Correlations and ORs for cylinder power and astigmatism were not statistically significant for most relationships considered. There were no statistically significant correlations or ORs for changes in any measure of refractive error.

CONCLUSIONS

The strong aggregation of refractive error, including myopia and hyperopia, among siblings along with weaker associations among parent-child and cousin pairs and no associations among spouses suggest a potential genetic influence on refractive error. There is no such suggestion for a genetic influence on the changes in refraction or in cylinder power and astigmatism.

Peak expiratory flow rate: relationship to risk variables and mortality: the Wisconsin Epidemiologic Study of diabetic retinopathy

OBJECTIVE

To examine correlates of peak expiratory flow rate in people with type 1 diabetes and to evaluate the relationship of peak expiratory flow rate to mortality.

RESEARCH DESIGN AND METHODS

A cohort study that was originally designed to determine the prevalence, incidence, and severity of diabetic retinopathy also provided the opportunity to measure peak expiratory flow rate. This was first measured at a 10-year follow-up and was evaluated in regard to risk factors for microvascular complications of diabetes. Mortality during 6 years of follow-up after the measurement was also ascertained.

RESULTS

In multivariable analysis, peak expiratory flow rate was associated with sex, age, height, BMI, history of cardiovascular disease, pulse rate, duration of diabetes, glycosylated hemoglobin, and end-stage renal disease. Peak expiratory flow rate was significantly associated with survival in categorical analyses. Even after considering age, sex, renal disease, history of cardiovascular disease, respiratory symptoms, duration of diabetes, cigarette smoking, and hypertension, peak expiratory flow rate was still significantly related to survival (hazard ratio 0.61 [95% CI 0.46-0.82]).

CONCLUSIONS

These data indicate that peak expiratory flow rate is associated with risk factors for other complications of diabetes. In addition, peak expiratory flow rate is a significant predictor of survival over even a relatively short period of time (6 years) in patients with younger-onset diabetes.

Is peak expiratory flow rate a predictor of complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy

The Objective of this study was to determine whether peak expiratory flow rate is a predictor of complications of diabetes. Peak expiratory flow rate was measured at the 10-year follow-up (third examination) of a cohort of persons with younger-onset diabetes. The relationships of progression of diabetic retinopathy by two steps, progression to proliferative retinopathy and of incidences of macular edema, sore or ulcers on feet or ankles, lower extremity amputation, proteinuria, and cardiovascular disease 4 years after this examination with respect to peak expiratory flow rate were evaluated. Study procedures including measurements of blood pressure, height and weight, grading of fundus photographs, peak expiratory flow rate, urinalysis, and medical history were performed according to standard protocols. Peak expiratory flow rate was not associated in univariate analyses with progression of retinopathy, incidences of proliferative retinopathy, macular edema or lower extremity amputation, sores or ulcers on feet or ankles, gross proteinuria, or self-reported cardiovascular disease. However, when using multivariable models to include the effects of other risk factors, peak expiratory flow rate was significantly associated with the combined incidences of sores or ulcers on feet and ankles, or lower extremity amputations (OR=0.61, 95% CI 0.42-0.88). These data suggest that peak expiratory flow rate is a predictor of subsequent complications in the lower extremities in those with long duration of younger-onset diabetes. Evaluating this association in an incipient cohort would illuminate whether the relationship we found is likely to be causal.

Cataract and hearing loss in a population-based study: the Beaver Dam studies

PURPOSE

Cataract and hearing loss are each common at older ages and together may influence the ability to function independently and affect the sense of well-being. For these reasons, we sought to estimate the risk factors for comorbidity of age-related cataract and hearing loss.

METHODS

A cross-sectional evaluation of a population-based cohort of older adults was conducted in Beaver Dam, Wisconsin, for presence of age-related cataract and hearing loss. The study evaluation included taking standardized medical histories, measuring blood pressures, and obtaining blood specimens. Standardized photographs, which were graded according to well-defined protocols to assess the presence of nuclear, cortical or posterior subcapsular cataract, were taken. Audiometric testing was performed according to well-defined study protocols.

RESULTS

Any type of cataract in combination with hearing loss in either ear was frequent, occurring in 27.8% of the population overall and increasing consistently with age. Nuclear and posterior subcapsular cataract in combination with hearing loss occurred more often in men. Lifestyle factors that were associated with at least one cataract-hearing loss end point in at least one sex were history of heavy drinking and smoking.

CONCLUSIONS

In this community, older adults appear to be at high risk of cataract and hearing loss. Although risk is strongly associated with age, some elective exposures appear to influence risk. It is possible that modification of certain lifestyle habits may alter these risks.

Changes in visual acuity in a population over a 10-year period : The Beaver Dam Eye Study

PURPOSE

To describe the change in visual acuity in a 10-year period.

DESIGN

Population-based cohort study.

PARTICIPANTS

Included 3684 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, living in Beaver Dam, Wisconsin, at a follow-up examination in 1993 to 1995 and/or 1998 to 2000.

METHODS

Best-corrected visual acuity was measured, after refraction, with logarithm of the minimum angle of resolution charts using a modification of the Early Treatment Diabetic Retinopathy Study protocol.

MAIN OUTCOMES MEASURES

Doubling of the visual angle and incidence of visual impairment.

RESULTS

The change in the mean number of letters read correctly over the 10-year period varied in the right eye from -0.9 (standard deviation [SD] = 5.5) and in the left eye from -1.2 (SD = 6.6) in people between 43 and 54 years of age to -11.0 (SD = 20.0) in the right eye and -12.6 (SD = 20.4) in the left eye in people 75 years of age or older (n = 184) at baseline. Over the 10-year period, 5.9% of the population had impaired vision (20/40 or worse in the better eye) develop, 0.8% had severe visual impairment (20/200 or worse in the better eye) develop, 4.8% had doubling of the visual angle, and 3.9% had improved vision. People who were 75 years of age or older at baseline were 15.0 times (95% confidence interval [CI], 10.9-20.6; P < 0.001) as likely to have impaired vision develop, 9.3 times (95% CI, 6.5-13.3; P < 0.001) as likely to have doubling of the visual angle, and 19.8 times as likely (95% CI, 8.4-46.4; P < or = 0.001) to have severe visual impairment develop than people younger than 75 years of age at baseline. For the 82 persons 75 years of age or older, currently residing in a nursing or group home at follow-up, they were 2.6 times (95% CI, 1.45-4.52) as likely to have impaired vision develop, 1.6 times (95% CI, 0.47-5.62) as likely to have severely impaired vision develop, and 3.6 times (95% CI, 1.96-6.78) as likely to have had a doubling of the visual angle than those not residing in a nursing or group home at follow-up.

CONCLUSIONS

These data provide precise population-based estimates of the 10-year incidence of loss of vision over a wide spectrum of ages and show that decreased visual acuity in people 75 years of age after 10 years is a common finding, especially in those who are admitted to nursing or group homes.

Measures of obesity and age-related eye diseases

OBJECTIVE

To compare body mass index with waist-to-hip ratio as correlates of age-related eye disease.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Participants of the Beaver Dam Eye Study at 5-year follow-up examinations.

METHODS

Body mass index was computed from weight and height, and waist-to-hip ratio was computed from measurements all done at the 5-year examination. Presence of ocular lesions was based on gradings of standard photographs of the retina and lens.

MAIN OUTCOME MEASURES

Presence of early and late age-related maculopathy and nuclear, cortical, and posterior subcapsular cataracts.

RESULTS

In women, early age-related maculopathy was significantly associated with both body mass index and waist-to-hip ratio. The relationship between waist-to-hip ratio and late age-related maculopathy was of borderline significance. When analyzed as continuous measures, waist-to-hip ratio was more strongly associated with nearly every outcome compared to body mass index. In men, there was little difference between body mass index and waist-to-hip ratio as correlates of age-related eye diseases. The reason for differences between men and women is not clear, but is unlikely to be due to current exposure to estrogen.

CONCLUSIONS

In women in our analyses, waist-to-hip ratio is more strongly associated with age-related eye disease than is body mass index. When adiposity is considered as a risk factor itself, or as a confounder of risk factors for age-related ocular disease, waist-to-hip ratio may be the better measure to use in women.

Medication use and the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study

OBJECTIVE

To evaluate incident early age-related maculopathy (ARM) after a 5-year interval with respect to medication use.

DESIGN

Population-based incidence study.

SETTING

Participants were adults aged 43 to 86 years living in Beaver Dam, Wis, when first examined in 1988-1990 (n = 4926); they were reexamined in 1993-1995 (n = 3684).

METHODS

All participants were examined and interviewed and stereoscopic color fundus photographs were taken. All procedures were done by standard protocol at both examinations. Incidence of ARM was based on grading using the Wisconsin ARM Grading System. All prescribed and over-the-counter medications in current use were brought to the examination site and the names were recorded at that time.

RESULTS

There were 678 drug preparations (active ingredients) being used at the baseline examination. No relations were found between most antihypertensive drugs, most central nervous system medications, aspirin and other nonsteroidal anti-inflammatory agents, estrogens, lipid-lowering agents, and incident early ARM over the 5-year period. Age- and sex-adjusted logistic regression analyses suggested possible associations (P<.10) between the use of phenothiazine antidopaminergics (odds ratio [OR], 2.83; 95% confidence interval [CI], 0.97-8.23; P =.06), desiccated thyroid hormones (OR, 2.32; 95% CI, 0.89-6.07; P =.09), and calcium channel blockers (OR, 1.70; 95% CI, 0.93-3.12; P =.08) with incident ARM. When additional information on past use was included in the regression model, the association remained for calcium channel blockers, but not for phenothiazines and desiccated thyroid hormones. A lower incidence of early ARM occurred in those who took antidepressants (OR, 0.34; 95% CI, 0.12-0.94; P =.04) at the baseline examination.

CONCLUSION

Although many different medications were being used at the baseline examination in the Beaver Dam Eye Study cohort, there were no striking associations with the 5-year incidence of early ARM.

Drug use and five-year incidence of age-related cataracts: The Beaver Dam Eye Study

OBJECTIVE

To evaluate incident cataract after a 5-year interval with respect to medication use.

DESIGN

Population-based incidence study.

MAIN OUTCOME

Incident cataract judged from standard photographs.

SETTING

Study subjects were adults 43 to 86 years of age in 1988 to 1990 and again in 1993 to 1995. All participants were examined and interviewed, and photographs were taken. All procedures and grading were done by protocols at both examinations. All medications in current use, prescribed as well as over-the-counter, were brought to the examination site, and the names were recorded at that time.

RESULTS

There were 678 drug preparations (active ingredients) being used at the baseline examination. Significantly lower incidences of nuclear cataracts 5 years later occurred in those who took thiazide diuretics (odds ratio [OR] = 0.79, 95% confidence interval [CI] 0.63, 1.00) and aspirin (OR = 0.76, 95% CI 0.61, 0.95) at the baseline examination. There were significantly more incident cortical cataracts in those taking oral steroids (OR = 2.59, 95% CI 1.45, 4.62), amitriptyline (OR = 2.03, 95% CI 1.09, 3.79), oral hypoglycemic agents (OR 2.06, 95% CI 1.23, 3.44), and insulin (OR = 3.38, 95% CI 1.61, 7.08). There were significantly more incident posterior subcapsular cataracts in those taking potassium-sparing diuretics (OR = 2.13, 95% CI 1.42, 3.18) and oral hypoglycemic agents (OR = 2.89, 95% CI 1.57, 5.33). Considering past use with never and current use did not alter the patterns of associations. We were not able to separate the effects of antihypertensive or diuretic agents from that of hypertension. However, hypoglycemic agents were no longer associated with any cataract type after stratifying by diabetes status.

CONCLUSIONS

Although many different medications were being used at the baseline examination in the Beaver Dam Eye Study cohort, few were associated with incident cataract. However, with the high frequency of use of medications and the possibility that effects of current exposure may occur in the future, it is reasonable to follow this and other older cohorts for the development of cataract.

Is the pulse rate useful in assessing risk of diabetic retinopathy and macular oedema? The Wisconsin Epidemiological Study of Diabetic Retinopathy

AIM

To describe the relation between pulse rate and incident diabetic retinopathy.

METHODS

Population based cohort study of people with diabetes. Resting pulse rate was measured in 30 second intervals. Diabetic retinopathy was evaluated from masked gradings of fundus photographs.

RESULTS

People with higher pulse rates were more likely to have 4 year progression of retinopathy, progression to proliferative retinopathy, and incident macular oedema than those with lower pulse rates. However, these associations were attenuated after controlling for blood pressure, glycosylated haemoglobin, and other risk factors.

CONCLUSION

Pulse rate may be a clinical indicator of overall risk of diabetic retinopathy, but is not independently associated with the condition.

Risk of incident age-related eye diseases in people with an affected sibling : The Beaver Dam Eye Study

The purpose of this investigation was to determine whether age-related cataract and maculopathy in older siblings predicts development of the same in younger siblings. A population-based study of age-related eye diseases was conducted in 1988--1990 in Beaver Dam, Wisconsin, and a follow-up examination was performed 5 years later. Diagnoses of age-related eye diseases were assigned on the basis of gradings of study photographs. There were 1,088 people from 488 sibships with at least two siblings who could contribute information for these analyses. The authors computed odds ratios and 95% confidence intervals for developing the specific lesion and identifying it 5 years later if an older sibling had it at baseline. The odds ratios were 1.65 (95% confidence interval (CI): 0.91, 2.99) for nuclear cataract, 1.62 (95% CI: 0.92, 2.85) for cortical cataract, 1.95 (95% CI: 0.48, 7.95) for posterior subcapsular cataract, 1.82 (95% CI: 0.91, 3.66) for soft drusen, 8.18 (95% CI: 3.34, 20.08) for retinal pigment epithelium depigmentation, 3.59 (95% CI: 1.71, 7.57) for increased retinal pigment, and 10.32 (95% CI: 0.83, 128.58) for exudative age-related maculopathy. These findings suggest that strong family determinants of lesions of age-related maculopathy are likely, less so for age-related cataract, which confer risk of the same lesion in a younger sibling.

The relation of coffee and caffeine to the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study

PURPOSE

To examine the relationship between coffee and caffeine consumption and the 5-year incidence of early age-related maculopathy and its component lesions, soft indistinct drusen or pigmentary abnormalities.

DESIGN

A prospective cohort study conducted from 1988 to 1995 with an average follow-up of 4.8 years.

METHODS

Data from baseline and 5-year follow-up examinations were analyzed for Beaver Dam Eye Study participants (n = 3435). The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of early age-related maculopathy.

RESULTS

Men were more likely to be coffee and caffeine drinkers than were women. For both men and women, coffee and caffeine intake decreased with age. Coffee and caffeine consumption were not associated with the 5-year incidence of early age-related maculopathy, soft indistinct drusen, or pigmentary abnormalities.

CONCLUSION

Neither a history of coffee nor caffeine consumption is associated with incident early age-related maculopathy.

Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality

Retinal microvascular abnormalities, such as generalized and focal arteriolar narrowing, arteriovenous nicking and retinopathy, reflect cumulative vascular damage from hypertension, aging, and other processes. Epidemiological studies indicate that these abnormalities can be observed in 2-15% of the nondiabetic general population and are strongly and consistently associated with elevated blood pressure. Generalized arteriolar narrowing and arteriovenous nicking also appear to be irreversible long-term markers of hypertension, related not only to current but past blood pressure levels as well. There are data supporting an association between retinal microvascular abnormalities and stroke, but there is no convincing evidence of an independent or direct association with atherosclerosis, ischemic heart disease, or cardiovascular mortality. New computer-related imaging methods are currently being developed to detect the presence and severity of retinal arteriolar narrowing and other microvascular characteristics. When reliably quantified, retinal microvascular abnormalities may be useful as risk indicators for cerebrovascular diseases.

Asteroid hyalosis in a population: the Beaver Dam eye study

PURPOSE

To estimate the prevalence of asteroid hyalosis and to examine correlates of asteroid hyalosis in a population-based cohort.

METHODS

The population of Beaver Dam, Wisconsin, that was 43 to 86 years of age was examined from 1988 to 1990 (n = 4926). The population is predominantly white (99.4%) northern European. Asteroid hyalosis was determined from stereoscopic fundus photographs of three standard fields.

RESULTS

Fundus photographs were gradable in 4747 subjects. Asteroid hyalosis was present in 1.2% (95% confidence interval, 0.9,1.5%). In subjects in which it was present, asteroid hyalosis was bilateral in 9%. Prevalence increased significantly (P <.001) with age from 0.2% in subjects 43 to 54 years to 2.9% in subjects 75 to 86 years. After adjusting for age, men were more likely (1.8%) to have asteroid hyalosis than women (0.8%). After adjusting for age and sex, asteroid hyalosis was significantly more likely to be found in subjects with greater body mass (P =.02) and higher alcohol consumption (P =.03). There were nonsignificant trends with systolic blood pressure (P =.07), serum cholesterol (P =.09), and serum albumin (P =.09). It was not significantly associated (P >.05) with diastolic blood pressure, hypertension, diabetes, cardiovascular disease history, high-density-lipoprotein cholesterol, serum calcium, cigarette smoking, physical activity, intraocular pressure, or refractive error. These relationships were confirmed in a multivariable logistic model.

CONCLUSIONS

The current study documents the infrequency of asteroid hyalosis in the population as graded from three photographic fields of the fundus. It does not support previous observations of an association of asteroid hyalosis with diabetes or refractive error. The relevance of the new associations reported (body mass, alcohol) remains to be determined.

The relation of socioeconomic factors to the incidence of early age-related maculopathy: the Beaver Dam eye study

PURPOSE

To investigate the relationship between socioeconomic factors and the 5-year incidence of age-related maculopathy.

METHODS

The Beaver Dam Eye Study, a population-based cohort study, examined 3681 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, at baseline and 5 years later. Standardized protocols for physical examination, including administration of a questionnaire that included questions regarding income, education level, and status and type of employment, and fundus photography to determine age-related maculopathy, were performed.

RESULTS

While controlling for age and sex, less education, and being in a service-related occupation compared with a white collar professional occupation, was associated (P <.05) with the incidence of early age-related maculopathy.

CONCLUSION

These data show an association of education and occupation but not income with the incidence of early age-related maculopathy that appears independent of smoking or vitamin supplement use status.

Refractive errors and incident cataracts: the Beaver Dam Eye Study

PURPOSE

To describe the relation between refractive errors and incident age-related cataracts in a predominantly white US population.

METHODS

All persons aged 43 to 84 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990 and a follow-up examination 5 years later from 1993 through 1995. At both examinations, participants had refraction and photographic assessment of cataract, according to a standardized protocol. Myopia was defined as a spherical equivalent of -1.0 diopters (D) or less, hyperopia as +1.0 D or more. The relations between refractive errors at baseline and cataract at baseline (prevalent cataract), 5-year incident cataract, and incident cataract surgery were analyzed by using generalized estimating equations.

RESULTS

When age and gender were controlled for, myopia was related to prevalent nuclear cataract (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.23-2.27), but not to cortical and posterior subcapsular cataracts. Myopia was not related to 5-year incident nuclear, cortical, and posterior subcapsular cataracts, but was related to incident cataract surgery (OR 1.89; CI 1.18-3.04). Hyperopia was related to incident nuclear (OR 1.56; CI 1.25-1.95) and possibly cortical (OR 1.25; CI 0.96-1.63) cataracts, but not to posterior subcapsular cataract or cataract surgery. After further adjustment for diabetes, smoking, and education, the association between myopia and incident cataract surgery was attenuated (OR 1.60; CI 0.96-2.64), but the associations between hyperopia and incident nuclear and cortical cataracts were unchanged.

CONCLUSIONS

These data support the cross-sectional association between myopia and nuclear cataract seen in other population-based studies, but provide no evidence of a relationship between myopia and 5-year incident cataract. Hyperopia may be related weakly to incident nuclear and cortical cataract.

The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus: the Wisconsin Epidemiologic Study of Diabetic Retinopathy

OBJECTIVES

To examine the association of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) overall and specific scale scores with visual acuity, diabetic retinopathy, and other characteristics, in a cohort of persons with type 1 diabetes.

DESIGN

Population-based cohort study.

SETTING

An 11-county area in southern Wisconsin.

PARTICIPANTS

Six hundred two persons with diabetes whose conditions were diagnosed when they were younger than 30 years and who were currently taking insulin participated in baseline, 4-year, 10-year, and 14-year follow-up examinations.

MAIN OUTCOME MEASURES

An interview that consisted of the 25-item NEI-VFQ was completed. Visual acuity was measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol and the presence and severity of retinopathy and macular edema were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the ETDRS retinopathy severity scheme.

RESULTS

Univariate analyses revealed that the total NEI-VFQ-25 score was lower in persons who were older, had a longer duration of diabetes, higher glycosylated hemoglobin, were in renal failure, had a history of cardiovascular disease, hypertension, or amputation of a lower limb, had poorer visual acuity, more severe diabetic retinopathy, macular edema, glaucoma, cataract, abnormalities in tactile sensation or temperature sensitivity, smoked more total pack-years, led a more sedentary lifestyle, and had poor peak expiratory flow. In multivariate analyses, while controlling for the physical and mental component scores from the Medical Outcomes Survey 36-Item Short-Form Health Survey as measures of comorbidity, lower total NEI-VFQ-25 scores were independently associated with poorer visual acuity, more severe retinopathy, older age, history of loss of tactile sensation, and more total pack-years of cigarettes smoked.

CONCLUSIONS

In this cross-sectional study, the 25-item NEI-VFQ seems to be strongly associated with vision, independent of severity of retinopathy and other complications associated with type 1 diabetes. It may be a useful measure of health-related quality of life as it relates to vision in epidemiological studies and clinical trials in persons with diabetes.

The relationship between ocular dimensions and refraction with adult stature: the Tanjong Pagar Survey

PURPOSE

To describe the association of ocular dimensions and refraction with adult stature.

METHODS

This was a population-based cross-sectional survey of adult Chinese aged 40 to 81 years residing in the Tanjong Pagar district in SINGAPORE: As part of the examination, ocular dimensions, including axial length, anterior chamber depth, lens thickness, and vitreous chamber depth, were measured using an A-mode ultrasound device. Corneal radius and refraction were determined with an autorefractor, with refraction further refined subjectively. Height (in meters) and weight (in kilograms) were measured using a standardized protocol, and body mass index (BMI) was calculated as weight divided by the square of the height (kilograms per square meter).

RESULTS

Data on ocular biometry, refraction, height, and weight were available on 951 (55.4%) participants with phakic eyes. After controlling for age, sex, education, occupation, housing type, income, and weight, it was found that taller persons were more likely to have longer axial lengths (+0.23 mm longer axial length, for every 0.10 m difference in height), deeper anterior chambers (+0.07 mm), thinner lenses (-0.09 mm), longer vitreous chambers (+0.26 mm), and flatter corneas (+0.09 mm longer corneal radius), although refractions were similar. In contrast, heavier persons tended to have more hyperopic refractions (+0.22 D for every 10 kg difference in weight, +0.56 D for every 10 kg/m(2) difference in BMI) but similar ocular dimensions.

CONCLUSIONS

Adult height is independently related to ocular dimensions, but does not appear to influence refraction. Thus, although taller persons are more likely to have longer globes, they also tend to have deeper anterior chambers, thinner lenses, and flatter corneas. Conversely, weight is independently related to refraction, although the exact biometric component responsible for this association is not apparent.

Risk factors for age-related macular degeneration: Pooled findings from three continents

OBJECTIVE

To assess the prevalence and potential risk factors for late age-related macular degeneration (AMD) in three racially similar populations from North America, Europe, and AUSTRALIA:

DESIGN

Combined analysis of population-based eye disease prevalence data.

PARTICIPANTS

There were 14,752 participants with gradable photographs from the Beaver Dam Eye Study (n = 4756), Rotterdam Study (n = 6411), and Blue Mountains Eye Study (n = 3585).

MAIN OUTCOME MEASURES

AMD diagnosis was made from masked grading of stereo macular photographs. Final classification of AMD cases was agreed by consensus between study investigators.

RESULTS

AMD prevalence was strongly age related. Overall, AMD was present in 0.2% of the combined population aged 55 to 64 years, rising to 13% of the population older than 85 years. Prevalence of neovascular AMD (NV) increased from 0.17% among subjects aged 55 to 64 years to 5.8% for those older than 85 years. Prevalence of pure geographic atrophy (GA) increased from 0.04% to 4.2% for these age groups. There were no significant gender differences in the prevalence of NV or GA. Subjects in the Rotterdam population had a significantly lower age-adjusted and smoking-adjusted risk of NV than subjects in the Beaver Dam and Blue Mountains populations. Apart from age, tobacco smoking was the only risk factor consistently associated with any form of AMD in all sites separately and in pooled analyses over the three sites.

CONCLUSIONS

These combined data from racially similar communities across three continents provide strong and consistent evidence that tobacco smoking is the principal known preventable exposure associated with any form of AMD.

How many steps of progression of diabetic retinopathy are meaningful? The Wisconsin epidemiologic study of diabetic retinopathy

OBJECTIVE

To determine whether a 1-step or more or 2-step or more progression on the Early Treatment Diabetic Retinopathy Study retinopathy severity scale over a 4-year period is meaningful in predicting the subsequent incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) over the following 6 years.

DESIGN

Population-based study of diabetic persons with 10 years of follow-up.

SETTING AND PATIENTS

Eleven-county area in southern Wisconsin. There were 1025 persons with diabetes who had fundus photographs at baseline and at 4- and 10-year follow-up examinations.

MAIN OUTCOME MEASURES

Incidence of PDR or CSME between the 4- and 10-year follow-up examinations as determined by masked grading of color stereoscopic fundus photographs of 7 standard fields.

RESULTS

In a univariate analysis, those with 1 or more steps of progression (n = 551) over the first 4 years of the study were significantly (P<.0001) more likely to develop PDR over the next 6 years than those with no progression (n = 474) (26% vs 4%) (relative risk, 5.85; 95% confidence interval, 4.05-8.47). Similarly, those with 2 or more (n = 364) (33%) or 3 or more (n = 231) (41%) steps of progression over the first 4 years of the study were significantly (P<.0001) more likely to develop PDR over the next 6 years than those with lesser progression (n = 661 [7%] and n = 794 [9%], respectively) (relative risk, 5.10; 95% confidence interval, 3.83-6.80; and relative risk, 4.61; 95% confidence interval, 3.57-5.99, respectively). Similar associations were apparent at every level of retinopathy, duration of diabetes, and glycosylated hemoglobin, and by type of diabetes at baseline. There were also associations between retinopathy progression and incidence of CSME.

CONCLUSIONS

It seems that 1 or more or 2 or more steps of progression of retinopathy over a 4-year period strongly predict the development of PDR over the next 6 years. Therefore, using these end points of progression would result in the need for fewer subjects or shorter follow-up in some clinical trials.

Sunlight and the 5-year incidence of early age-related maculopathy: the beaver dam eye study

OBJECTIVE

To investigate the relation of sunlight exposure and indicators of sun sensitivity with the 5-year incidence of early age-related maculopathy (ARM).

DESIGN

Longitudinal, population-based study. Participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were reexamined from 1993 to 1995, 5 years after the baseline examination. Questionnaire data about sunlight exposure and sun sensitivity were obtained at baseline. Additional information about earlier life patterns of exposure was ascertained at follow-up. Stereoscopic color fundus photographs were graded to determine the presence of ARM at the 5-year follow-up in eyes free from signs of early ARM at the baseline examination.

RESULTS

Leisure time spent outdoors while persons were teenagers (aged 13-19 years) and in their 30s (aged 30-39 years) was significantly associated with the risk of early ARM (odds ratio, 2.09; 95% confidence interval, 1.19-3.65). There was a slight, but nonsignificant, protective effect associated with use of hats and sunglasses while persons were teenagers and in their 30s (odds ratio, 0.72; 95% confidence interval, 0.50-1.03). People with red or blond hair were slightly more likely to develop early ARM than people with darker hair (odds ratio, 1.33; 95% confidence interval, 0.97-1.83). There were no associations between estimated ambient UV-B exposure or markers of sun sensitivity and the incidence of early ARM.

CONCLUSION

Exposure to sunlight may be associated with the development of early ARM.

Association of leisure-time noise exposure and hearing loss

The purpose of this study was to investigate the association of noisy leisure activities with hearing loss. Participants (n=3571) were examined in a population-based study of age-related hearing loss conducted in Beaver Dam, Wisconsin. Hearing thresholds were determined by audiometry. Hearing loss was defined as the pure-tone average of the frequencies 500, 1,000, 2,000, and 4,000 Hz greater than 25 dB HL in either ear. Information regarding exposure to leisure-time noise was obtained by interview. After adjusting for potential confounders, individuals who engaged in leisure activities with average sound levels greater than 90 dBA were significantly more likely to have a hearing loss than participants who did not engage in noisy leisure activities (OR=1.11, 95 per cent CI=1.01-1.22). Individuals who engaged in woodworking were 30 per cent more likely to have a hearing loss than those who had never done woodworking. There was a 6 per cent increased risk of hearing loss for each 5-year period of participation. Health care professionals should consider counseling their patients who engage in noisy leisure activities about the risk of noise-induced hearing loss.

Diphtheria and hearing loss

OBJECTIVE

To determine if infectious diseases usually experienced in childhood have an effect on hearing ability later in life.

METHODS

The Epidemiology of Hearing Loss Study (N = 3,753) is a population-based study of age-related hearing loss in adults aged 48 to 92 years in Beaver Dam, Wisconsin. As part of this study, infectious disease history was obtained and hearing was tested using pure-tone audiometry. Hearing loss was defined as a pure-tone average of thresholds at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz greater than 25 decibels hearing level in either ear.

RESULTS

After adjusting for confounders, only a history of diphtheria (n = 37) was associated with hearing loss (odds ratio [OR] 2.79; 95% confidence interval [CI] 1.05, 7.36). There was no relationship between hearing loss and history of chickenpox, measles, mumps, pertussis, polio, rheumatic fever, rubella, or scarlet fever. Only two participants with a history of diphtheria and hearing loss reported having a hearing loss before age 20.

CONCLUSIONS

Diphtheria in childhood may have consequences for hearing that do not become apparent until later in life. A possible biological mechanism for a diphtheria effect on hearing ability exists: The toxin produced by the Corynebacterium diphtheriae bacteria can cause damage to cranial nerves and therefore may affect the auditory neural pathway. These data may have important implications for areas facing a resurgence of diphtheria cases.

Lens thickness and five-year cumulative incidence of cataracts: The Beaver Dam Eye Study

PURPOSE

To evaluate whether lens thickness is related to incidence of cataracts.

METHODS

Lens thickness was measured from slit-lamp photographs of the lens at the time of the prevalence evaluation in the Beaver Dam Eye Study. Incident cataract was determined by grading standard slit-lamp and retroillumination photographs of the lens at the baseline and five-year follow-up examinations. Medical history was obtained and blood pressures, height and weight were measured according to protocol.

RESULTS

Lens thickness was positively associated with incident nuclear cataract and inversely associated with incident cortical cataract after accounting for age, sex, diabetes status, hypertension, heavy drinking and cigarette smoking.

CONCLUSIONS

Lens thickness is related to incidence of cataracts. Mechanisms to explain these relationships require further laboratory and epidemiologic investigation.

The prevalence and 5-year incidence of ocular trauma. The Beaver Dam Eye Study

PURPOSE

To describe the cumulative lifetime prevalence and 5-year incidence of ocular trauma and their relation to risk factors in a defined white adult population living in a small town.

DESIGN

Population-based cross-sectional and follow-up study.

PARTICIPANTS

Participants aged 43 to 86 years from the baseline Beaver Dam Eye Study that took place from 1988 through 1990 (n = 4926) and the follow-up study that took place from 1993 through 1995 (n = 3684).

METHODS

Standardized interview at baseline and follow-up study.

MAIN OUTCOME MEASURES

Cumulative lifetime prevalence and 5-year incidence of self-reported history of ocular trauma.

RESULTS

The cumulative lifetime prevalence and 5-year incidence of ocular trauma was 19.8% (n = 972) and 1.6% (n = 57), respectively. A history of trauma in both eyes was reported in 15% of the prevalent cases and 8% of the incident cases. Sharp objects caused more than half of all injuries. Persons aged 43 through 54 years were 2.5 times more likely to have a lifetime history of ocular trauma than persons aged 75 and older (odds ratios [OR], 2.57; 95% confidence interval [CI], 2.0, 3.29). Males had four times the prevalence of females (OR, 4. 42; 95% CI, 3.79, 5.16). Almost one third of all males aged 43 through 54 years reported a history of ocular trauma in their lifetime. The higher risks in the 43 through 54 age group (OR, 1.60) and male gender (OR, 1.42) were not significant among incident cases. In multivariate analysis, blue collar (adjusted OR, 1.58; 95% CI, 1. 32, 1.89) and farm-related workers (adjusted OR, 1.32; 95% CI, 0.93, 1.87) had higher lifetime risks of ocular trauma compared with white collar workers. People with a history of fractures also had increased lifetime risks (adjusted OR, 1.30; 95% CI, 1.13, 1.52). A history of ocular trauma reported in the baseline examination was significantly associated with a higher risk of ocular trauma occurring again in the next 5 years (adjusted OR, 3.27; 95% CI, 1.76, 5.82), especially if both eyes had previous trauma (adjusted OR, 5.15; 95% CI, 2.03, 13.0).

CONCLUSIONS

One fifth of white adult Americans more than 42 years of age residing in a small town reported ocular trauma in their lifetime. This group had a three times higher risk of experiencing ocular trauma again within 5 years.

Moderate alcohol consumption and hearing loss: a protective effect

OBJECTIVE

To determine if moderate alcohol consumption is associated inversely with hearing loss in a large population based study of older adults.

DESIGN

Cross-sectional population based cohort study. Data are from the 1993-1995 examinations for the population based Epidemiology of Hearing Loss Study (EHLS) (n = 3571) and the Beaver Dam Eye Study (BDES) (n = 3722).

SETTING

Midwestern community of Beaver Dam, Wisconsin.

PARTICIPANTS

Residents of Beaver Dam aged 43 to 84 in 1987-1988 were eligible for the BDES (examinations in 1988-1990 and 1993-1995). During 1993-1995, this same cohort was eligible to participate in the baseline examination for the EHLS.

MEASUREMENTS

Hearing thresholds were measured by pure tone air and bone conduction audiometry (250-8000 Hz.). History of alcohol consumption in the past year, heavy drinking (ever), medical history, occupation, noise exposure, and other lifestyle factors were ascertained by a questionnaire that was administered as an interview.

RESULTS

In multiple logistic regression analyses controlling for potential confounders, moderate alcohol consumption (>140 grams/week) was inversely associated with hearing loss (PTA(.5,1,2,4 > 25 dB HL); odds ratio [OR] = .71, 95% confidence interval [CI] = .52, .97; where PTA is pure tone average). A similar association was found for moderate hearing loss (PTA(.5,1,2,4 > 40 dB HL); OR = 0.49, 95% CI = 0.32, 0.74). Alcohol consumption was associated inversely with the odds of having a low frequency hearing loss (OR = 0.61) or a high frequency hearing loss (OR = 0.60). These findings did not vary significantly by age or gender. There was an increase in the odds of having a high frequency hearing loss (OR = 1.35, 95% CI = 1.04, 1.75), in those with a history of heavy drinking (> or =4 drinks/day). Including cardiovascular disease or its related factors did not significantly attenuate the protective effect.

CONCLUSIONS

There is evidence of a modest protective association of alcohol consumption and hearing loss in these cross-sectional data. This finding is in agreement with a small body of evidence suggesting that hearing loss is not an inevitable component of the aging process.

A short questionnaire on visual function of older adults to supplement ophthalmic examination

PURPOSE

To estimate frequency of self-reported visual dysfunction in specific life situations.

METHODS

Performance-based measures of visual function were obtained during the 5-year follow-up examination of the Beaver Dam Eye Study cohort. During the subsequent yearly follow-up telephone call, four questions concerning visual abilities in specific situations were administered.

RESULTS

Visual difficulties in everyday life situations were commonly reported by adults aged 48 to 91 years, with only 17% to 35% of persons reporting excellent or very good vision in the four specific situations related to visual function. Visual acuity, near vision, and contrast sensitivity measures do not reflect the visual difficulties encountered in common daily activities in our study population (Spearman correlation coefficients all less than 0.35).

CONCLUSIONS

A few simple questions about visual function in common daily activities may give a clinician insights into patient complaints. It may be that environmental changes could improve self-reported visual function.

Reproductive exposures, incident age-related cataracts, and age-related maculopathy in women: the beaver dam eye study

PURPOSE

To evaluate the relationship of reproductive exposures and incident age-related cataract and maculopathy in women.

METHODS

This was a population-based cohort study including all adults 43 to 84 years of age living in Beaver Dam, Wisconsin (a representative midwestern community) who were identified during a census in 1987 to 1988. They were evaluated initially in 1988 to 1990 and at follow-up in 1993 to 1995. Evaluations included medical histories and both fundus and lens photography. All procedures were done according to protocols that were the same at both examinations. All photographs were graded by trained observers using defined grading schemes. The severities of age-related cataracts and maculopathy were determined by grading of photographs. Information on hormone exposures was ascertained from structured interviews.

RESULTS

After adjusting for age, the only significant finding for lens end points was a trend indicating a possible protective effect of increasing number of live births and incident posterior subcapsular cataract. There were no significant associations of any reproductive exposure with lesions of early or late age-related maculopathy.

CONCLUSIONS

In these population-based data, there is little evidence of association of hormone exposures with incident age-related eye disease in women 5 years later. Longer follow-up of this population, whose mean age is approaching that of heightened incidence, may disclose significant relationships.

Prevalence of and risk factors for dry eye syndrome

OBJECTIVE

To examine risk factors for the prevalence of dry eye syndrome in a population-based cohort.

METHODS

The prevalence of dry eye was determined by history at the second examination (1993-1995) of the Beaver Dam Eye Study cohort (N = 3722).

RESULTS

The cohort was aged 48 to 91 years (mean +/- SD, 65 +/- 10 years) and 43% male. The overall prevalence of dry eye was 14.4%. Prevalence varied from 8.4% in subjects younger than 60 years to 19. 0% in those older than 80 years (P<.001 for test of trend). Age-adjusted prevalence in men was 11.4% compared with 16.7% in women (P<.001). After controlling for age and sex, the following factors were independently and significantly associated with dry eye in a logistic model: history of arthritis (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.56-2.33), smoking status (past, OR, 1.22; 95% CI, 0.97-1.52; current, OR, 1.82; 95% CI, 1.36-2.46), caffeine use (OR, 0.75; 95% CI, 0.61-0.91), history of thyroid disease (OR, 1.41; 95% CI, 1.09-1.84), history of gout (OR, 1.42; 95% CI, 1.02-1.96), total to high-density lipoprotein cholesterol ratio (OR, for 1 unit, 0.93; 95% CI, 0.88-0.99), diabetes (OR, 1.38; 95% CI, 1.03-1.86), and multivitamin use (past, OR, 1.35; 95% CI, 1. 01-1.81; current, OR, 1.41; 95% CI, 1.09-1.82). Nonsignificant variables included body mass; blood pressure; white blood cell count; hematocrit; history of osteoporosis, stroke, or cardiovascular disease; history of allergies; use of antihistamines, parasympathetics, antidepressants, diuretics, antiemetics, or other drying drugs; alcohol consumption; time spent outdoors; maculopathy; central cataract; and lens surgery.

CONCLUSION

The results suggest several factors, such as smoking, caffeine use, and multivitamin use, could be studied for preventive or therapeutic efficacy. Arch Ophthalmol. 2000;118:1264-1268

Are retinal arteriolar abnormalities related to atherosclerosis?: The Atherosclerosis Risk in Communities Study

The objective of this study was to describe associations of retinal arteriolar abnormalities with clinical and subclinical manifestations of atherosclerosis and a broad group of risk factors for vascular disease. A biracial population of 8772 adults (aged 48 to 72 years) living in 4 communities was examined from 1993 to 1995 were studied for that purpose. Retinal arteriovenous nicking and focal arteriolar narrowing were determined by light-box grading of a 45 degrees fundus photograph by use of a standardized protocol. Diameters of arterioles and venules were measured in digitized photographs, and a summary arteriolar-to-venular ratio was derived as an index of generalized arteriolar narrowing. Focal arteriolar narrowing was associated only with hypertension. Generalized arteriolar narrowing was associated with carotid plaque but not with any other evidence of atherosclerosis, either clinical (cardiovascular disease or stroke) or subclinical (carotid or popliteal artery thickness or lower limb obstructive disease), or with plasma cholesterol. It was also associated with smoking, with inflammatory markers (white blood cell count, fibrinogen, and reduced albumin), and with the triglyceride and high density lipoprotein cholesterol changes associated with inflammation. Arteriovenous nicking was inconsistently associated with subclinical atherosclerosis. It was not associated with cardiovascular disease, stroke, or plasma cholesterol. Arteriovenous nicking was associated with markers of inflammation and vascular endothelial dysfunction (von Willebrand factor and factor VIII). Arteriolar narrowing and nicking appear to be related to hypertension and inflammatory factors. Nicking may also be related to endothelial dysfunction. Results suggest that these arteriolar changes are pathologically distinct from atherosclerosis. Including their measurement in population studies may permit evaluation of the independent contribution of arteriolar disease to various ischemic diseases of the heart, brain, and other organs.

Arcus senilis and mortality in a population with diabetes

PURPOSE

To estimate the prevalence of arcus senilis and its association with mortality in a diabetic population.

METHODS

A cohort of persons with younger (n = 996) and older onset (n = 1,370) diabetes was examined. Mortality information was obtained from death certificates.

RESULTS

Prevalence of arcus senilis increased with age and was higher in men than in women. In the younger onset group, it was also associated with a history of cardiovascular disease. As a risk factor for mortality after controlling for age and sex, arcus senilis was not associated with death from all causes, ischemic heart disease, or stroke.

CONCLUSION

Arcus senilis provides no more information about mortality risk than age of the person.

The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus

BACKGROUND

Despite the numerous studies on the relation of albuminuria with increased risk of all-cause mortality in type 2 diabetes mellitus, it remains uncertain whether microalbuminuria and/or gross proteinuria are independent risk factors for cardiovascular mortality. Moreover, the association of albuminuria with cardiovascular mortality in people with type 2 diabetes mellitus has not been well described in US populations.

OBJECTIVE

To estimate the relative risks (RRs) for the associations of microalbuminuria and gross proteinuria with cardiovascular disease mortality among persons with older-onset diabetes mellitus.

METHODS

We conducted a prospective cohort study of 840 people with older-onset diabetes mellitus who provided urine samples in the 1984-1986 examination of a population-based study of diabetic persons. The presence of microalbuminuria was determined by an agglutination inhibition assay and gross proteinuria by a reagent strip. The main outcome was time to mortality from cardiovascular disease, as determined from death certificates.

RESULTS

Of the 840 older-onset diabetic persons, 54.8% had normoalbuminuria, while 24.8% had microalbuminuria and 20.5% had gross proteinuria. During the 12-year follow-up (6127 person-years), we identified 364 deaths from cardiovascular disease. Compared with persons with normoalbuminuria, those with microalbuminuria and gross proteinuria had significantly higher risks of cardiovascular mortality. The RR as controlled for age, sex, glycemic control, insulin use, alcohol intake, physical activity, cardiovascular disease history, antihypertensive use, and retinopathy severity, was 1.84 (95% confidence interval [CI], 1.42-2.40) for those with microalbuminuria and 2.61 (95% CI, 1.99-3.43) for those with gross proteinuria. Further adjustment for other factors did not change the relations we found. When the end point used was mortality from coronary heart disease, stroke, or all causes, the increased risks were significant for both microalbuminuria (adjusted RRs [95% CIs], 1.96 [1.42-2.72], 2.20 [1.29-3.75], and 1.68 [1.35-2.09], respectively) and gross proteinuria (adjusted RRs [95% CIs], 2.73 [1.95-3.81], 2.33 [1.28-4.24], and 2.47 [1.97-3.10], respectively).

CONCLUSIONS

Results from our population-based study strongly suggest that both microalbuminuria and gross proteinuria were significantly associated with subsequent mortality from all causes and from cardiovascular, cerebrovascular, and coronary heart diseases. These associations were independent of known cardiovascular risk factors and diabetes-related variables.

Recreational firearm use and hearing loss

OBJECTIVE

To assess the relation between recreational firearm use and high-frequency hearing loss in a population of older adults.

DESIGN

Cross-sectional, population-based cohort study.

SETTING

The midwestern community of Beaver Dam, Wis.

PARTICIPANTS

A population-based sample of 3753 participants (83% of those eligible), aged 48 to 92 years, participated in the baseline phase of the Epidemiology of Hearing Loss Study.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Lifetime and past year self-reported firearm use during target shooting and hunting were assessed by interview. Hearing thresholds were measured by pure-tone audiometry.

RESULTS

After age and other factors were adjusted for, men (n = 1538) who had ever regularly engaged in target shooting (odds ratio, 1.57; 95% confidence interval, 1.12-2.19) or who had done so in the past year (odds ratio, 2.00; 95% confidence interval, 1.15-3.46) were more likely to have a marked high-frequency hearing loss than those who had not. Risk of having a marked high-frequency hearing loss increased 7% for every 5 years the men had hunted (odds ratio, 1.07; 95% confidence interval, 1.03-1.12). Thirty-eight percent of the target shooters and 95% of the hunters reported never wearing hearing protection while shooting in the past year.

CONCLUSIONS

These results indicate that use of recreational firearms is associated with marked high-frequency hearing loss in men. There is a need for further education of users of recreational firearms regarding the risk of hearing impairment associated with firearm use and the availability and importance of appropriate hearing protection.

Exposure to diagnostic x-rays and incident age-related eye disease

OBJECTIVE

The purpose of this study was to evaluate whether a self-reported history of computed tomography or other x-rays of the head were associated with the incidence of age-related cataracts and maculopathy five years later.

METHOD

A 5-year longitudinal follow-up of the Beaver Dam Eye Study cohort (n=3,684, 43-86 years at baseline).

RESULTS

There was no evidence of a relationship between the x-ray exposures and the incidence of nuclear or cortical cataracts, or early maculopathy. There was a significant relationship to the incidence of posterior subcapsular cataract after adjusting for age only.

CONCLUSIONS

Adult patients in whom medical conditions warrant diagnostic x-rays of the head appear to be at little or no increased risk of age-related cataract or maculopathy. However, research efforts with more precise measures of x-ray exposure, longer follow-up, and further attempts to define uncontrolled confounders are warranted.

The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study

PURPOSE

To describe the prevalence and the 5-year incidence of retinal central and branch vein occlusion and associated risk factors.

METHODS

The Beaver Dam Eye Study (n = 4,926) is a population-based study in which retinal vein occlusions were detected at baseline (1988-1990) and at a 5-year follow-up examination (1993-1995) by grading of 30 degrees color fundus photographs.

RESULTS

The prevalence and 5-year incidence of retinal branch vein occlusion were each 0.6%. The prevalence of retinal central vein occlusion was 0.1%, and the 5-year incidence was 0.2%. While adjusting for age, the prevalence of branch vein occlusion was associated with hypertension (odds ratio [OR] 5.42, 95% confidence interval [CI] 2.18, 13.47), diabetes mellitus (OR 2.43, 95% CI 1.04, 5.70), pulse pressure (OR 1.24 for 10 mm Hg, 95% CI 1.03, 1.48), ocular perfusion pressure (OR 2.09 for 10 mm Hg, 95% CI 1.45, 3.01), arteriovenous nicking (OR 16.75, 95% CI 7.33, 38.24), and focal arteriolar narrowing (OR 22.86, 95% CI 8.43, 62.03). The age-adjusted incidence of retinal branch vein occlusion was associated with current smoking (OR 4.43 95%, CI 1.53, 12.84) compared with nonsmokers and to focal arteriolar narrowing (OR 5.24, 95% CI 1.97, 13.94) at baseline. While controlling for age, the incidence of branch vein occlusion was not associated with serum lipid levels, body mass index, white blood cell count, alcohol consumption, aspirin use, glaucoma, intraocular pressure, or ocular hypertension.

CONCLUSIONS

Retinal vein occlusion is infrequent in the population. These data suggest a strong association between retinal branch vein occlusion and retinal arteriolar changes. Data from larger populations are needed to further assess associations between risk factors and the incidence of retinal vein occlusions.

Incident cataract after a five-year interval and lifestyle factors: the Beaver Dam eye study

CONTEXT

A population-based study to investigate risk factors for age-related eye disease was begun in 1987 in a representative American community. Incidence of cataract was subsequently evaluated.

SPECIFIC OBJECTIVES

To examine the relationships of cigarette smoking, alcohol, and caffeine intakes to incidence of age-related cataracts five years later.

DESIGN

Observational epidemiologic incidence study of an adult population.

PARTICIPANTS AND INTERVENTION

Adults 43-84 years of age were identified during a census in 1987-1988, and examined at baseline (1988-1990) and after a five-year interval (1993-1995).

MAIN OUTCOME MEASURE

Standardized protocols were used at the baseline and follow-up evaluations for exposures and for objective identification of cataracts.

RESULTS

Cumulative incidence of nuclear cataract in right eyes was about 12%, cortical cataract about 8%, and posterior subcapsular cataract about 3%. In multivariable analyses of the general estimating equations type, there were significant associations between nuclear cataract and: pack-years smoked (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01, 1.09 per 10 pack-years); and current alcohol intake (OR 1.01, 95% CI 1.00, 1.02 per 10 grams ethanol/week). Cigarette smokers were more likely to have had cataract surgery in the interval between baseline and follow-up examinations.

CONCLUSIONS

Cigarette smoking and alcohol consumption were associated with modestly increased risks of incident nuclear cataract over a five-year interval.

Exogenous estrogen exposures and changes in diabetic retinopathy. The Wisconsin Epidemiologic Study of Diabetic Retinopathy

OBJECTIVE

To investigate whether the use of exogenous estrogen is associated with changes in the severity of diabetic retinopathy and the incidence of macular edema.

RESEARCH DESIGN AND METHODS

The study design involved observation of two well-defined cohorts of women with diabetes. One group was diagnosed with diabetes at < 30 years of age and used insulin (younger-onset group), and the other group was diagnosed at > or = 30 years of age with no criteria regarding therapy (older-onset group). Subjects received standard examinations, medical interviews, and retinal photography in 1980-1982. Specific questions about exogenous hormone exposure were added to the study questionnaire at the first follow-up examination 4 years after the baseline examination. Change in the severity of retinopathy 6 and 10 years after the 4-year follow-up examination were examined regarding the use of oral contraceptives at the first follow-up examination in the younger-onset group and at 6 years after the first follow-up examination regarding hormone replacement therapy in the older-onset group.

RESULTS

Changes in the severity of retinopathy and incidence of macular edema were unrelated to either type of estrogen exposure in univariable and multivariable analyses.

CONCLUSIONS

These data are compatible with the hypothesis that the medications used by our population do not affect the severity of diabetic retinopathy or macular edema.

Is serum cholesterol associated with progression of diabetic retinopathy or macular edema in persons with younger-onset diabetes of long duration?

PURPOSE

To quantitate the relationships of total cholesterol and high-density lipoprotein cholesterol to the incidence and progression of diabetic retinopathy and macular edema 5 years later in those with younger-onset diabetes of long duration.

METHODS

Casual serum specimens for lipid values and fundus photography at the time of the lipid determinations were evaluated with regard to retinal lesions in photographs taken 5 years later during the course of a population-based cohort study.

RESULTS

Univariable associations were significant for associations of incident retinal lesions with total cholesterol/high-density lipoprotein cholesterol, but multivariable associations considering covariates were not significant.

CONCLUSION

Our data suggest that lowering cholesterol by therapeutic means may not be indicated for the sole purpose of decreasing the incidence or progression of these retinal lesions.

Association of ocular disease and mortality in a diabetic population

OBJECTIVE

To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population.

DESIGN

Geographically defined population-based cohort study.

SETTING

An 11-county area in Wisconsin.

STUDY POPULATION

Participants were all younger-onset diabetic persons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabetic persons (diagnosed as having diabetes at > or =30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years.

MAIN OUTCOME MEASURE

All-cause and cause-specific mortality as determined from death certificates.

RESULTS

In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality.

CONCLUSIONS

Presence of more severe retinopathy or visual impairment in diabetic patients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.

Correlates of urinary symptom scores in men

OBJECTIVES

This study determined the prevalence of urinary symptoms and their relationship to characteristics of a cohort of men in Beaver Dam, Wis, from 1993 to 1995.

METHODS

A standardized questionnaire concerning urinary symptoms (the American Urological Association Urinary Symptom Questionnaire) was administered.

RESULTS

All outcomes were associated with age and history of enlarged prostate. Urinary frequency (57%) and nocturia (65%) were the most common individual symptoms. Diuretic usage, diabetes, history of cardiovascular disease, and smoking were related to specific symptoms.

CONCLUSIONS

While urinary symptoms are associated with age and history of enlarged prostate, symptoms may also be attributable to other diseases and exposures.